This application will extend a successful NIDCR-funded bi-level oral health self-management pilot conducted among older/disabled adults residing in one older adult residential building to six buildings and evaluate it using a modified fractional factorial design. The theoretical framework is based on Fishbein's modified theory of reasoned action called the Integrated Model (IM) of Behavioral Prediction. It is operationalized through Adapted Motivational Interviewing, an interactive tailored cognitive approach, and Practice-to-Mastery (AMI-PM). The intervention includes two components: 1) a face to face administration of the AMI-PM;and 2) a targeted building-level campaign that includes principles of practice to master (CA-PM).
The specific aims are to: 1) Test the two main components of a bi-level intervention to improve clinical oral hygiene outcomes in relation to one another, and through differential sequencing. 2) Identify cognitive and behavioral mechanisms contributing to clinical oral hygiene outcomes. 3) Assess impact and sustainability of behavioral and clinical outcomes over time. The intervention will be carried out in three cycles of 150 participants each for a total of N=450. Each cycle will include two buildings matched by size and ethnic/linguistic composition housing older adults and those with disabilities. In one condition, the individual leve intervention will be introduced followed by the group level intervention. In the second condition, the group level intervention will precede the individual level. Survey and clinical measures taken at baseline, and following the administration of the first and second components. This design will enable comparison of the short term efficacy of the individual versus group level component (T1 - T2) and the shorter and longer term efficacy of the interventions (T3 - 3 months). Clinical measures at T4, 6 months later, will evaluate sustainability of effect. Primary outcome measures are gingival index and plaque score, both of which improved significantly in the pilot study. Significance lies in the potential of the intervention to address critical disparities in oral healh through oral health promotion initiatives in the locations where they reside as well as the ability to evaluate the intervention efficiently using a design alternative to the RCT.

Public Health Relevance

The proposed study's primary significance lies in the potential of this bi-level intervention to address significant disparities in oral health and consequent morbidity or reduced quality of life among vulnerable, low-income and primarily minority older adults and those with disabilities through prevention in the locations where they reside. The intervention could provide a model for programs to reduce oral health disparities across Connecticut and nationally.